- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $74.13 / $144.54
| Facility | | $28.84 | $74.13 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $28.84 / $37.15
| Professional | | $19.95 | $28.84 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $165.96
| Facility | | $38.90 | $38.90 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $15.49 / $26.30
| Professional | | $15.14 | $15.49 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $93.33 / $138.04
| Professional | | $57.54 | $93.33 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $67.61 / $177.83
| Facility | | $38.90 | $67.61 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $19.95 / $38.90
| Professional | | $12.88 | $19.95 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $46.77 / $57.54
| Professional | | $38.90 | $46.77 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $33.11 / $38.02
| Professional | | $16.22 | $33.11 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $28.18 / $33.11
| Facility | | $19.05 | $28.18 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $16.98 / $81.28
| Professional | | $5.62 | $16.98 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $46.77 / $10,000.00
| Facility | | $16.22 | $46.77 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $46.77 / $10,000.00
| Professional | | $16.98 | $46.77 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $38.90 / $46.77
| Facility | | $16.22 | $38.90 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $16.22 / $23.44
| Professional | | $6.46 | $16.22 | $23.44 |